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Insurance Claims Specialist

Centivo

United States Full-time in I.T. & Communications
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    • Job ID 2106351

    Job Description

    Join our dynamic team at Centivo, where we are passionately dedicated to transforming healthcare for workers and their employers. Located in Buffalo with a hybrid remote work option, we’re inviting enthusiastic individuals to apply for the role of Claims Processor, offering competitive pay between $18 and $20 per hour.

    At Centivo, our mission is clear: we strive to provide affordable, high-quality healthcare solutions to those who face challenges in managing their medical expenses. As a Claims Processor, you will play a crucial role in supporting our self-funded employer groups by managing and processing healthcare claims efficiently.

    Your responsibilities will include:

    • Adjudicating healthcare claims in allocated work queues following Centivo’s policies and the terms set forth in the Summary Plan Documents (SPDs) for our clients.
    • Thoroughly reviewing system-generated edits on claims to ensure that benefits are applied according to client SPDs and funds are managed appropriately.
    • Collaborating closely with the Claims Supervisor, Account Managers, and various teams, ensuring timely and accurate adjudication of claims.
    • Identifying and resolving any inconsistencies in plan interpretations by routing claims to the relevant teams for further review.
    • In instances requiring additional information, appropriately denying claims and effectively communicating with participants or providers to clarify data needs.
    • Maintaining required production levels as outlined in Claims Department Policies and Procedures.
    • Actively participating in departmental quality improvement initiatives and suggesting process enhancements that drive efficiency.

    To thrive in this role, you should possess:

    • Prior experience with automated and integrated claims processing systems.
    • A solid understanding of healthcare claims, medical coding, and the applicable rules surrounding Benefit Plans.
    • Strong critical thinking skills and the ability to make independent decisions with minimal supervision.
    • A High School diploma or GED.
    • Excellent communication skills, both verbal and written.
    • The capability to manage multiple tasks in a fast-paced environment while adhering to production schedules and deadlines.
    • Proficiency in Microsoft Office and other web-based applications, along with a willingness to learn new proprietary systems.

    While not mandatory, the following qualifications would be advantageous:

    • An associate or bachelor’s degree.

    If you are looking to make a difference in the healthcare industry while enjoying the flexibility of hybrid work, we encourage you to apply through our company website. Join us at Centivo and help us redefine healthcare for countless individuals!

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